In this study, attempts have been made to assess oral health status of psychiatric patients and factors related to dental caries and periodontal status in JUSH. The study had two limitations. First, despite its higher chance of detecting dental caries and the need for treatment, we could not use X-ray imaging; rather we used physical (dental) examination for assessing dental caries. The second was lack of literatures on the subject at a country level for comparison and discussion purposes.
Oral health status was assessed by DMFT score which is a measure of dental caries and CPI as periodontal status indicator. The mean DMFT score in our study was 1.94±2.12 (mean±SD), which was greater than general population of Ethiopian immigrants to Israel with mean DMFT of 1.48±3.16 
. In contrast, the findings of Jovanović et al
, Zusman et al
, Lewis et al
, Ramon et al
, Chu et al
, Rekha et al
and Adeniyi et al
demonstrated mean DMFT score of 24.4, 23.8, 19.1, 17.5, 13.9, 6.1 and 2.3 respectively, which were higher than this study. The lower DMFT index in this study might be due to difference in age ranges, type of medication taken by psychiatric patients and duration of illness among study subjects. The mean number of decayed teeth in this study was 1.28. This finding was consistent with a study conducted by Kumar et al
. In contrast, it was lower than studies reported by Jovanović et al
, Zusman et al
and Ramon et al
. A 0.51 mean of number of missed teeth was also reported in this study and it was lower than studies conducted in Israel 
, Serbia 
and South Wales 
. The mean number of filled teeth was 0.14. This finding was similar to a study conducted by Adeniyi et al
and lower than studies by Lewis et al
and Zusman et al
. This is possibly suggestive of reduced access to dental service and care of the study psychiatric patients than for those in developed countries.
Results of multiple logistic regression showed that mean DMFT was associated with sex of study subjects. Being male is a risk factor for development of dental caries. This finding is supported by the result of Jovanović et al
and male subjects might, due to culture, have a higher probability of chewing khat and smoking compared to females who generally do not indulge in these habits. At the same time, age has been associated with DMFT. An increase in age raised the mean DMFT score in the study; this was consistent with previous findings 
. Marital status, ethnicity and educational level had no significant association with dental caries. Absence of association between dental caries and educational level was also reported in studies conducted by Adeniyi et al
and Chu et al
Mean DMFT score also increased with the duration of mental illness, tooth brushing technique and sweet intake. Kumar et al
and Jovanović et al
also reported the association of DMFT scores with duration of mental illness. This study demonstrated statistical association between taking anti-psychotic and anti-depressant treatments and dental caries. The relation of anti-depressant treatment is in accordance with a study done in Serbia 
. This could probably be because of anti-psychotropic and anti-depressant medications which result in reduced saliva thus causing mouth dryness and exposing study subjects for dental caries 
. The association of smoking with dental caries was also observed in this study and the results are similar to studies by Millar et al
and Ravald et al
. We further found DMFT index association with chewing khat in univariate analysis. This finding may provide a new risk factor, which has not yet been reported for dental caries.
In this study, about 27% of psychiatric patients demonstrated periodontal pockets (shallow or deep pockets), whereas it was 5.3% 
in a study conducted among the general population of Ethiopian immigrants to Israel. This clearly shows a higher degree of periodontal disease in psychiatric patients than the general population of Ethiopia.
Multinomial logistic regression analysis showed sex, marital status and educational level to be associated with periodontal status. In contrast, the finding of Jovanović et al
demonstrated its association with sex and absence of association with marital status. Females showed better periodontal conditions in this study possibly due to the culture and norm that prevents female subjects from chewing khat and smoking practices. Likewise, we found that tooth brushing technique, sweet intake habit, medication type and illness duration being statistically associated with periodontal disease predicted with CPI values. This could be explained by the fact that all of the patients already had very high CPI scores and hence there was almost no variation in this value.
In conclusion, our psychiatric patients have a poor oral health status. Therefore, health education about oral hygiene to avoid high and frequent intake of sweets, smoking and horizontal tooth brushing should be given for psychiatric patients. When psychiatric patients are prescribed for anti-depressants, the effect of the treatment should be taken into consideration and psychiatric patients could be referred to dental clinic for preventative measures.